Provider Demographics
NPI:1982992806
Name:KRASSELT, LESLIE KAY HOWE (LMP, MMT)
Entity Type:Individual
Prefix:
First Name:LESLIE
Middle Name:KAY HOWE
Last Name:KRASSELT
Suffix:
Gender:F
Credentials:LMP, MMT
Other - Prefix:
Other - First Name:LESLIE
Other - Middle Name:KAY
Other - Last Name:MANLEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMP
Mailing Address - Street 1:12015 MARINE DR # 425
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9306
Mailing Address - Country:US
Mailing Address - Phone:425-280-0621
Mailing Address - Fax:
Practice Address - Street 1:12015 MARINE DR # 3425
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-9306
Practice Address - Country:US
Practice Address - Phone:425-280-0621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-12
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00023447174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist